Cervical Cancer: Screening, Education, Hope

Women from villages in the remote mountains of Honduras wait to register for an NCCC-sponsored, two day cervical cancer screening and breast education clinic.

NCCC physicians and researchers brought information and hope to the rural village women. The data they brought back to their labs for complex analysis will provide Honduran physicians information they need to create a comprehensive national plan to fight cervical cancer in Honduras.

The women travelled from 16 farming villages in the remote mountains of Honduras—some leaving at 4 a.m.–for "La Jornada," a cervical cancer screening and breast education clinic. Rooms in the school in El Rosario (a rural village of about 400 residents) were filled with exam tables and cubicles that villagers had made from trees cut earlier in the week. For two days researchers and physicians from La Liga Contra el Cancer in Honduras and Norris Cotton Cancer Center (NCCC) worked all day, screening 472 women for cervical cancer and human papillomavirus (HPV), leading information sessions on preventing HPV and how to do a breast self-exam,and guiding the women through an 8-minute survey about their background and education. The turnout was unprecedented as was the Jornada. Cancer prevention and screening is new to these rural villages.

La Jornada was a collaborative effort, organized by NCCC Director of Community Affairs Linda Kennedy, who worked with village leaders and oncologists from La Liga Contra el Cancer in San Pedro Sula, an urban center a 3-hour drive from El Rosario. As they offered cancer screening to the women, the organizers gathered information that NCCC researchers will analyze and share with physicians from La Liga, who are creating a comprehensive national plan to fight cervical cancer in Honduras. Women at the clinic who needed further care were connected to appropriate health professionals.

After screening for cervical cancer, women attended information sessions on preventing HPV and how to do a breast self-exam.

Cervical cancer, which is almost always caused by an HPV infection, is the most common cancer in women in Honduras and the first cancer among women 15-49 years of age. Vaccinating against HPV has helped cut cervical cancer rates in other nations, but it is not available there. And because Honduran women with cervical cancer are not diagnosed early, the cancer 5-year survival rate is below 2 percent.

"This is a cancer that is wholly preventable," Kennedy said. "But with no education, screening, or connection to treatment, rural Honduran women are at a tremendous risk for cervical cancer."

She describes the collaboration as mutually beneficial for all involved: The village women needed health information and access to cancer screening. The Honduran oncologists needed data and complex analysis to develop a plan that could mitigate their nation's cervical cancer problem. Cancer prevention education and population-based research are part of NCCC's work, and extending our research platform beyond clinical care is critical to our mission as a designated comprehensive cancer center.

At "La Jornada" each woman had a pap smear, evaluated by pathologists in Honduras, and was also tested for HPV. The HPV test is not available in Honduras, so the swabs were brought back to the NCCC lab of molecular pathologist Greg Tsongalis to identify the specific strains of HPV. Using the HPV and pap results along with other collected data, NCCC investigator Tracy Onega will complete a population based analysis of the disease. This information will be shared with the La Liga Contra el Cancer to create a Honduran cervical cancer database that can be used to inform a cancer prevention policy.

NCCC Director of Community Affairs Linda Kennedy (holding banner) worked with village leaders from El Rosario and oncologists from La Liga Contra el Cancer to organize a two-day cervical cancer screening clinic on October 26-27 2013.

They village women all know cancer is a problem: they've watched loved ones die from the disease for years. But information can empower people to act. What they learned about breast health and cervical cancer from Dr. Mary Chamberlin will help them identify potential problems and take action to get further screening. The test results each woman receives will identify those who have cancer now, and they will be connected to immediate treatment.

"It is a joy to help women who realize that they have a health problem, and to help them resolve it," said Gloria Castro, an organizer in El Rosario after a long day at the Jornada.

One of the women who travelled to the clinic did not come for cervical testing or to learn about breast health care. A mother of four, she had a football-sized tumor growing in one of her breasts. Gloria knew there was an urban cancer center, but since had no money to travel 3 hours to get there she had been waiting, frightened and alone, as her tumor doubled in size in 4 weeks,

After examining her, the Jornada physicians encouraged Gloria to have treatment, including surgery and radiation. She found the courage to take the next step and was in surgery the following week.

"Coming here was a solution," she said. "I feel like an angel fell to me from the sky. Talking to doctors Ana and Mary gave me hope. Now I have a lot more hope"

When the NCCC team returned to Lebanon in October they left funds to cover Gloria's transportation to La Liga Contra el Cancer—they recently heard that her surgery was successful and she is healing well.